Provider Demographics
NPI:1225140965
Name:LUTHERAN CHILD AND FAMILY SERVICES OF INDIANA/KENTUCKY, INC.
Entity Type:Organization
Organization Name:LUTHERAN CHILD AND FAMILY SERVICES OF INDIANA/KENTUCKY, INC.
Other - Org Name:LCFS
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-359-5467
Mailing Address - Street 1:1525 N RITTER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3026
Mailing Address - Country:US
Mailing Address - Phone:317-359-5467
Mailing Address - Fax:317-322-4095
Practice Address - Street 1:1525 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3026
Practice Address - Country:US
Practice Address - Phone:317-359-5467
Practice Address - Fax:317-322-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73545 49-900998323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000487150OtherANTHEM PROVIDER NUMBER